<h:html xmlns:h="http://www.w3.org/1999/xhtml"
        xmlns="http://www.w3.org/2002/xforms"
	xmlns:ev="http://www.w3.org/2001/xml-events"
	xmlns:xsd="http://www.w3.org/2001/XMLSchema"
	xmlns:jr="http://openrosa.org/javarosa">
<h:head>
    <h:title>HMIS 033b: Health Unit Weekly Epidemiological Surveillance Form</h:title>
    <model>
	<instance>
			<HMISFormB xmlns="http://gatherdata.org/en_UG/hmis033b">
				<Meta>
					<DeviceID />
					<TimeStart />
					<TimeEnd />
				</Meta>
			
				<DateOfReport/>
				<FromDate/>
				<ToDate/>
				<HealthUnit/>
				<HealthUnitCode/>
				<SubCounty/>
				<HSD/>
				<District/>
				<AcuteFlaccidParalysis>
					<CasesThisWeek/>
					<DeathsThisWeek/>
					<CasesLastWeek/>
					<DeathsLastWeek/>
				</AcuteFlaccidParalysis>
				<AnimalBites>
					<CasesThisWeek/>
					<DeathsThisWeek/>
					<CasesLastWeek/>
					<DeathsLastWeek/>
				</AnimalBites>
				<Rabies>
					<CasesThisWeek/>
					<DeathsThisWeek/>
					<CasesLastWeek/>
					<DeathsLastWeek/>
				</Rabies>
				<Cholera>
					<CasesThisWeek/>
					<DeathsThisWeek/>
					<CasesLastWeek/>
					<DeathsLastWeek/>
				</Cholera>
				<Dysentery>
					<CasesThisWeek/>
					<DeathsThisWeek/>
					<CasesLastWeek/>
					<DeathsLastWeek/>
				</Dysentery>
				<GuineaWorm>
					<CasesThisWeek/>
					<DeathsThisWeek/>
					<CasesLastWeek/>
					<DeathsLastWeek/>
				</GuineaWorm>
				<Malaria>
					<CasesThisWeek/>
					<DeathsThisWeek/>
					<CasesLastWeek/>
					<DeathsLastWeek/>
				</Malaria>
				<Measles>
					<CasesThisWeek/>
					<DeathsThisWeek/>
					<CasesLastWeek/>
					<DeathsLastWeek/>
				</Measles>
				<Meningitis>
					<CasesThisWeek/>
					<DeathsThisWeek/>
					<CasesLastWeek/>
					<DeathsLastWeek/>
				</Meningitis>
				<NeonatalTetanus>
					<CasesThisWeek/>
					<DeathsThisWeek/>
					<CasesLastWeek/>
					<DeathsLastWeek/>
				</NeonatalTetanus>
				<Plague>
					<CasesThisWeek/>
					<DeathsThisWeek/>
					<CasesLastWeek/>
					<DeathsLastWeek/>
				</Plague>
				<YellowFever>
					<CasesThisWeek/>
					<DeathsThisWeek/>
					<CasesLastWeek/>
					<DeathsLastWeek/>
				</YellowFever>
				<OtherViralFevers>
					<CasesThisWeek/>
					<DeathsThisWeek/>
					<CasesLastWeek/>
					<DeathsLastWeek/>
				</OtherViralFevers>
				<OtherEmergingDiseases>
					<CasesThisWeek/>
					<DeathsThisWeek/>
					<CasesLastWeek/>
					<DeathsLastWeek/>
				</OtherEmergingDiseases>
				<ActionsTakenByHealthUnit/>
				<Remarks/>
				<NameOfInCharge/>
			</HMISFormB>		
	</instance>

		<bind id="hidden1" nodeset="/HMISFormB/Meta/DeviceID" type="xsd:string" jr:preload="property" jr:preloadParams="DeviceID" />
		<bind id="hidden2" nodeset="/HMISFormB/Meta/TimeStart" type="dateTime" jr:preload="timestamp" jr:preloadParams="start" />	
		<bind id="hidden3" nodeset="/HMISFormB/Meta/TimeEnd" type="dateTime" jr:preload="timestamp" jr:preloadParams="end" />

		<bind id="prop1" nodeset="/HMISFormB/HealthUnit" type="xsd:string" jr:preload="property" jr:preloadParams="health-unit" />
		<bind id="prop2" nodeset="/HMISFormB/HealthUnitCode" type="xsd:string" jr:preload="property" jr:preloadParams="health-unit-code" />
		<bind id="prop3" nodeset="/HMISFormB/SubCounty" type="xsd:string" jr:preload="property" jr:preloadParams="sub-county" />
		<bind id="prop4" nodeset="/HMISFormB/HSD" type="xsd:string" jr:preload="property" jr:preloadParams="hsd" />
		<bind id="prop5" nodeset="/HMISFormB/District" type="xsd:string" jr:preload="property" jr:preloadParams="district" />

		<bind id="a" nodeset="/HMISFormB/DateOfReport" type="xsd:date" jr:preload="date" jr:preloadParams="today" />
		<bind id="b" nodeset="/HMISFormB/FromDate" type="xsd:date" jr:preload="date" jr:preloadParams="prevperiod-week-mon-head" />
		<bind id="c" nodeset="/HMISFormB/ToDate" type="xsd:date" jr:preload="date" jr:preloadParams="prevperiod-week-mon-tail" />
		<bind id="d" nodeset="/HMISFormB/AcuteFlaccidParalysis/CasesThisWeek" type="xsd:int"/>
		<bind id="e" nodeset="/HMISFormB/AcuteFlaccidParalysis/DeathsThisWeek" type="xsd:int"/>
		<bind id="f" nodeset="/HMISFormB/AcuteFlaccidParalysis/CasesLastWeek" type="xsd:int"/>
		<bind id="g" nodeset="/HMISFormB/AcuteFlaccidParalysis/DeathsLastWeek" type="xsd:int"/>
		<bind id="h" nodeset="/HMISFormB/AnimalBites/CasesThisWeek" type="xsd:int"/>
		<bind id="i" nodeset="/HMISFormB/AnimalBites/DeathsThisWeek" type="xsd:int"/>
		<bind id="j" nodeset="/HMISFormB/AnimalBites/CasesLastWeek" type="xsd:int"/>
		<bind id="k" nodeset="/HMISFormB/AnimalBites/DeathsLastWeek" type="xsd:int"/>
		<bind id="l" nodeset="/HMISFormB/Rabies/CasesThisWeek" type="xsd:int"/>
		<bind id="m" nodeset="/HMISFormB/Rabies/DeathsThisWeek" type="xsd:int"/>
		<bind id="n" nodeset="/HMISFormB/Rabies/CasesLastWeek" type="xsd:int"/>
		<bind id="o" nodeset="/HMISFormB/Rabies/DeathsLastWeek" type="xsd:int"/>
		<bind id="p" nodeset="/HMISFormB/Cholera/CasesThisWeek" type="xsd:int"/>
		<bind id="q" nodeset="/HMISFormB/Cholera/DeathsThisWeek" type="xsd:int"/>
		<bind id="r" nodeset="/HMISFormB/Cholera/CasesLastWeek" type="xsd:int"/>
		<bind id="s" nodeset="/HMISFormB/Cholera/DeathsLastWeek" type="xsd:int"/>
		<bind id="t" nodeset="/HMISFormB/Dysentery/CasesThisWeek" type="xsd:int"/>
		<bind id="u" nodeset="/HMISFormB/Dysentery/DeathsThisWeek" type="xsd:int"/>
		<bind id="v" nodeset="/HMISFormB/Dysentery/CasesLastWeek" type="xsd:int"/>
		<bind id="w" nodeset="/HMISFormB/Dysentery/DeathsLastWeek" type="xsd:int"/>		
		<bind id="x" nodeset="/HMISFormB/GuineaWorm/CasesThisWeek" type="xsd:int"/>
		<bind id="y" nodeset="/HMISFormB/GuineaWorm/DeathsThisWeek" type="xsd:int"/>
		<bind id="z" nodeset="/HMISFormB/GuineaWorm/CasesLastWeek" type="xsd:int"/>
		<bind id="aa" nodeset="/HMISFormB/GuineaWorm/DeathsLastWeek" type="xsd:int"/>
		<bind id="ab" nodeset="/HMISFormB/Malaria/CasesThisWeek" type="xsd:int"/>
		<bind id="ac" nodeset="/HMISFormB/Malaria/DeathsThisWeek" type="xsd:int"/>
		<bind id="ad" nodeset="/HMISFormB/Malaria/CasesLastWeek" type="xsd:int"/>
		<bind id="ae" nodeset="/HMISFormB/Malaria/DeathsLastWeek" type="xsd:int"/>
		<bind id="af" nodeset="/HMISFormB/Measles/CasesThisWeek" type="xsd:int"/>
		<bind id="ag" nodeset="/HMISFormB/Measles/DeathsThisWeek" type="xsd:int"/>
		<bind id="ah" nodeset="/HMISFormB/Measles/CasesLastWeek" type="xsd:int"/>
		<bind id="ai" nodeset="/HMISFormB/Measles/DeathsLastWeek" type="xsd:int"/>
		<bind id="aj" nodeset="/HMISFormB/Meningitis/CasesThisWeek" type="xsd:int"/>
		<bind id="ak" nodeset="/HMISFormB/Meningitis/DeathsThisWeek" type="xsd:int"/>
		<bind id="al" nodeset="/HMISFormB/Meningitis/CasesLastWeek" type="xsd:int"/>
		<bind id="am" nodeset="/HMISFormB/Meningitis/DeathsLastWeek" type="xsd:int"/>
		<bind id="an" nodeset="/HMISFormB/NeonatalTetanus/CasesThisWeek" type="xsd:int"/>
		<bind id="ao" nodeset="/HMISFormB/NeonatalTetanus/DeathsThisWeek" type="xsd:int"/>
		<bind id="ap" nodeset="/HMISFormB/NeonatalTetanus/CasesLastWeek" type="xsd:int"/>
		<bind id="aq" nodeset="/HMISFormB/NeonatalTetanus/DeathsLastWeek" type="xsd:int"/>
		<bind id="ar" nodeset="/HMISFormB/Plague/CasesThisWeek" type="xsd:int"/>
		<bind id="as" nodeset="/HMISFormB/Plague/DeathsThisWeek" type="xsd:int"/>
		<bind id="at" nodeset="/HMISFormB/Plague/CasesLastWeek" type="xsd:int"/>
		<bind id="au" nodeset="/HMISFormB/Plague/DeathsLastWeek" type="xsd:int"/>
		<bind id="av" nodeset="/HMISFormB/YellowFever/CasesThisWeek" type="xsd:int"/>
		<bind id="aw" nodeset="/HMISFormB/YellowFever/DeathsThisWeek" type="xsd:int"/>
		<bind id="ax" nodeset="/HMISFormB/YellowFever/CasesLastWeek" type="xsd:int"/>
		<bind id="ay" nodeset="/HMISFormB/YellowFever/DeathsLastWeek" type="xsd:int"/>
		<bind id="az" nodeset="/HMISFormB/OtherViralFevers/CasesThisWeek" type="xsd:int"/>
		<bind id="ba" nodeset="/HMISFormB/OtherViralFevers/DeathsThisWeek" type="xsd:int"/>
		<bind id="bb" nodeset="/HMISFormB/OtherViralFevers/CasesLastWeek" type="xsd:int"/>
		<bind id="bc" nodeset="/HMISFormB/OtherViralFevers/DeathsLastWeek" type="xsd:int"/>
		<bind id="bd" nodeset="/HMISFormB/OtherEmergingDiseases/CasesThisWeek" type="xsd:int"/>
		<bind id="be" nodeset="/HMISFormB/OtherEmergingDiseases/DeathsThisWeek" type="xsd:int"/>
		<bind id="bf" nodeset="/HMISFormB/OtherEmergingDiseases/CasesLastWeek" type="xsd:int"/>
		<bind id="bg" nodeset="/HMISFormB/OtherEmergingDiseases/DeathsLastWeek" type="xsd:int"/>
    </model>
</h:head>			
<h:body>
        <input bind="a">
     	    <label>Date of Report</label>
        </input>
       <input bind="b">
            <label>For period</label>
        </input>
        <input bind="c">
            <label>To...</label>
        </input>

        <input bind="prop1">
            <label>Health Unit</label>
        </input>
        <input bind="prop2">
            <label>Health Unit Code</label>
        </input>
        <input bind="prop3">
            <label>Sub-county</label>
        </input>

        <input bind="prop4">
            <label>HSD</label>
        </input>
        <input bind="prop5">
            <label>District</label>
        </input>

<input bind="d"><label>Acute Flaccid Paralysis: Cases This Week</label></input>
<input bind="e"><label>Acute Flaccid Paralysis: Deaths This Week</label></input>
<input bind="f"><label>Acute Flaccid Paralysis: Cases Last Week</label></input>
<input bind="g"><label>Acute Flaccid Paralysis: Deaths Last Week</label></input>
<input bind="h"><label>Animal Bites: Cases This Week</label></input>
<input bind="i"><label>Animal Bites: Deaths This Week</label></input>
<input bind="j"><label>Animal Bites: Cases Last Week</label></input>
<input bind="k"><label>Animal Bites: Deaths Last Week</label></input>
<input bind="l"><label>Rabies: Cases This Week</label></input>
<input bind="m"><label>Rabies: Deaths This Week</label></input>
<input bind="n"><label>Rabies: Cases Last Week</label></input>
<input bind="o"><label>Rabies: Deaths Last Week</label></input>
<input bind="p"><label>Cholera: Cases This Week</label></input>
<input bind="q"><label>Cholera: Deaths This Week</label></input>
<input bind="r"><label>Cholera: Cases Last Week</label></input>
<input bind="s"><label>Cholera: Deaths Last Week</label></input>
<input bind="t"><label>Dysentery: Cases This Week</label></input>
<input bind="u"><label>Dysentery: Deaths This Week</label></input>
<input bind="v"><label>Dysentery: Cases Last Week</label></input>
<input bind="w"><label>Dysentery: Deaths Last Week</label></input>
<input bind="x"><label>Guinea Worm: Cases This Week</label></input>
<input bind="y"><label>Guinea Worm: Deaths This Week</label></input>
<input bind="z"><label>Guinea Worm: Cases Last Week</label></input>
<input bind="aa"><label>Guinea Worm: Deaths Last Week</label></input>
<input bind="ab"><label>Malaria: Cases This Week</label></input>
<input bind="ac"><label>Malaria: Deaths This Week</label></input>
<input bind="ad"><label>Malaria: Cases Last Week</label></input>
<input bind="ae"><label>Malaria: Deaths Last Week</label></input>
<input bind="af"><label>Measles: Cases This Week</label></input>
<input bind="ag"><label>Measles: Deaths This Week</label></input>
<input bind="ah"><label>Measles: Cases Last Week</label></input>
<input bind="ai"><label>Measles: Deaths Last Week</label></input>
<input bind="aj"><label>Meningitis: Cases This Week</label></input>
<input bind="ak"><label>Meningitis: Deaths This Week</label></input>
<input bind="al"><label>Meningitis: Cases Last Week</label></input>
<input bind="am"><label>Meningitis: Deaths Last Week</label></input>
<input bind="an"><label>Neonatal tetanus: Cases This Week</label></input>
<input bind="ao"><label>Neonatal tetanus: Deaths This Week</label></input>
<input bind="ap"><label>Neonatal tetanus: Cases Last Week</label></input>
<input bind="aq"><label>Neonatal tetanus: Deaths Last Week</label></input>
<input bind="ar"><label>Plague: Cases This Week</label></input>
<input bind="as"><label>Plague: Deaths This Week</label></input>
<input bind="at"><label>Plague: Cases Last Week</label></input>
<input bind="au"><label>Plague: Deaths Last Week</label></input>
<input bind="av"><label>Yellow Fever: Cases This Week</label></input>
<input bind="aw"><label>Yellow Fever: Deaths This Week</label></input>
<input bind="ax"><label>Yellow Fever: Cases Last Week</label></input>
<input bind="ay"><label>Yellow Fever: Deaths Last Week</label></input>
<input bind="az"><label>Other Viral Heamorrhagic Fevers: Cases This Week</label></input>
<input bind="ba"><label>Other Viral Heamorrhagic Fevers: Deaths This Week</label></input>
<input bind="bb"><label>Other Viral Heamorrhagic Fevers: Cases Last Week</label></input>
<input bind="bc"><label>Other Viral Heamorrhagic Fevers: Deaths Last Week</label></input>
<input bind="bd"><label>Other emerging infectious diseases: Cases This Week</label></input>
<input bind="be"><label>Other emerging infectious diseases: Deaths This Week</label></input>
<input bind="bf"><label>Other emerging infectious diseases: Cases Last Week</label></input>
<input bind="bg"><label>Other emerging infectious diseases: Deaths Last Week</label></input>


		<input ref="/HMISFormB/ActionsTakenByHealthUnit">
			<label>Actions taken by the health unit</label>
		</input>
		<input ref="/HMISFormB/Remarks">
			<label>Remarks</label>
		</input>
		<input ref="/HMISFormB/NameOfInCharge">
			<label>Name of in-charge</label>
		</input>

</h:body>
</h:html>



